(Attachment 1) Local Government Officials Training Program in Japan Trainee Application Form
Photograph ① Applicant Name (Taken Within the Please type or print your name in the standard alphabet format. Past 3 Months) ______4cm high× 3cm wide Please clarify the order of you name as it appears officially in your passport.
______/______Surname (Family Name) Given Name(s)
② Nationality ______
3 Sex Male Female ✔ Check the appropriate box.
4 Date / Place of Birth Date: _____Year/ ______Month/ _____Day Place:______
5 Dietary Restrictions: (Including those due to medical or religious reasons) 6 Marital Status Married Single ✔ Check the appropriate box
7 Occupation (Please clearly type or print your employer’s full contact details as the host institution and CLAIR will be getting in touch with you via post should you be selected to participate in the program.) Department Provincial / Municipal Government Name Workplace
Postal Code Work Address
Your Position/
Title Fax Number Work Work E- Telephone (Mobile) mail Contact Person (Position/Title) Telephone (Supervisor） (Name) Fax Number
8 Home Address Full home address, telephone number, and 2 contact persons in your home country in case of an emergency. Home Postal Code Address Fax number Home
Telephone Your Personal E-mail Emergency Contacts Name Relation Tel/Fax (2 people ) Name Relation Tel/Fax
⑨ Do you have a passport? Yes No ✔ Check the appropriate box. Passport Number Date of Issue Issuing Date of Expiration Authority
⑩ Have you ever been to Japan? Yes No ✔ Check the appropriate box. (If yes, please indicate when, where, and why)
11 Educational Institutions Attended (in chronological order) Qualification(s) Name of Institution Period Attended Specialization Earned ～ ～ ～
12 Qualifications (Please indicate if you have any special language qualifications, etc) Type of Qualification Date Received
⑬ Work Experience (in chronological order) Period Employer Position / Description of Work
～ ～ ～ ～ ～
⑭ Have you received any overseas training before? Yes No ✔Check the appropriate box. Country/Host Organization Training Period Content of Training (Please be specific） ～ ～
⑮ Details of Desired Field of Training (1) Please indicate your desired field of training as well as detailed, specific reasons for your application. (If the space provided is insufficient, please use additional sheets of paper.)
Desired field of training ______
(i) Focusing on your desired field of training, please outline the current situation and pressing issues that must be addressed in your local government.
(ii) Please indicate specific details of what you would like to learn while in Japan. Please include details of institutions you would like to visit, events you would like to attend, technologies you would like to study, etc.
(iii) Please indicate how you would apply what you have learned in Japan to your work upon returning to your home country.
(2) Please provide a detailed description of your work experiences focusing on aspects relating to your desired field of training in Japan. (If the space provided is insufficient, please use additional sheets of paper.)
⑯ Experience in Desired Field of Training (Please summarize item (2) of section ⑮ ) Period Details of Experience ～
～
⑰ Language Ability ✔ Check the most appropriate response Japanese English Listening □ None □ None □ Greetings and basic sentences □ Greetings and basic sentences □ Daily conversations □ Daily conversations □ Can understand Japanese radio or TV □ Others’ opinions about general topics □ No trouble understanding native speakers □ News, speeches, debates Speaking □ None □ None □ Greetings and basic sentences □ Greetings and basic sentences □ Daily conversations □ Daily conversations □ Expressing opinions about □Expressing opinions about general topics general topics □Native-level communication skills □Native-level communication skills Reading □ None □ None □ Hiragana □ Katakana □ Simple sentences with dictionary □ Some Chinese characters （ □ Letters, etc without dictionary characters） □ Simple newspaper articles □ Simple newspaper articles □ Advanced newspaper articles □ Advanced newspaper articles Writing □ None □ None □ Hiragana □ Katakana □ Simple sentences with dictionary □ Some Chinese characters （ □ Letters, etc without dictionary characters） □ Short paragraphs on general topics □Short paragraphs on general topics □ Summaries and expressing opinions □ Summaries and expressing opinions
⑱ Language Learning (Please type or print in detail) Period/Frequency Method/Content of Qualification(s) Language Institution of Study Study Earned
Japanese
English
Languages other than your mother tongue ⑲ Period Available for Training 20 May 2018 ～ / / Day Month Year * Training is between 6 to 12 months. The exact length of your stay in Japan will be decided by your host institution upon consideration of your individual circumstances.
I hereby apply for the position of “Cooperation and Exchange Trainee (CET)” with the attached Written Pledge and Medical Checkup Sheet. I pledge that the above stated information is true and factual.
____Day ______Month ______Year
Signature of Applicant ______
------(To be filled out by the applicant’s department head)
I hereby certify that the above Application Form and the attached Medical Checkup Sheet are accurate. I also believe the applicant to be a suitable candidate for this training program, and recommend the applicant wholeheartedly.
____Day ______Month ______Year
Name of Organization ______
Address ______
______
______Fax______Tel ______Name of Department Head ______Signature of Department Head _